Provider Demographics
NPI:1730129958
Name:TANG, SHIH T (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIH
Middle Name:T
Last Name:TANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHIH
Other - Middle Name:TUO
Other - Last Name:TANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1085 N HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2417
Mailing Address - Country:US
Mailing Address - Phone:714-776-7006
Mailing Address - Fax:714-776-7666
Practice Address - Street 1:1085 N HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2417
Practice Address - Country:US
Practice Address - Phone:714-776-7006
Practice Address - Fax:714-776-7666
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A532000Medicaid
CAWA53200BOtherPPIN
CA00A532000Medicaid
CAG31959Medicare UPIN